Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid www.mass.gov/masshealth MassHealth All Provider Bulletin 289 March 2020 TO: All Providers Participating in MassHealth FROM: Daniel Tsai, Assistant Secretary for MassHealth RE: MassHealth Coverage and Reimbursement Policy for Services Related to Coronavirus Disease 2019 (COVID-19) Background MassHealth’s mission is to improve the health outcomes of our diverse members and their families by providing access to integrated health care services that sustainably and equitably promote health, well-being, independence and quality of life. In support of that mission, MassHealth provides broad coverage of medically necessary health care services to its members. In light of the state of emergency declared in the Commonwealth due to the 2019 novel Coronavirus (COVID-19) outbreak, MassHealth is introducing additional flexibilities for coverage and billing related to COVID-19, as further described in this bulletin. This bulletin applies to members enrolled in MassHealth fee-for-service, the Primary Care Clinician (PCC) Plan, or a Primary Care ACO. Information about coverage through MassHealth Managed Care Entities is included in MCE Bulletin 21. Program of All-inclusive Care for the Elderly (PACE) organizations should follow the guidance set forth in this bulletin and in MCE Bulletin 21 when delivering services to MassHealth members. The Massachusetts Executive Office of Health and Human Services (EOHHS) is coordinating with federal and local partners to respond to COVID-19. As this situation evolves, EOHHS may issue additional guidance on this topic as informed and directed by the Massachusetts Department of Public Health (DPH) and the federal Centers for Disease Control and Prevention (CDC). This bulletin shall remain effective for the duration of the state of emergency declared via Executive Order No. 591. Eligibility In order to enhance access to health care services during the COVID-19 outbreak, MassHealth is expanding its Hospital-Determined Presumptive Eligibility (HPE) process to allow qualified hospitals to render HPE determinations for individuals previously ineligible for HPE, provided that they have a diagnosis or a presumptive diagnosis of COVID-19. Additional detail regarding this policy is available in All Provider Bulletin 288. Additional detail regarding MassHealth eligibility initiatives related to COVID-19 will appear in a forthcoming Eligibility Operations Memo. MassHealth All Provider Bulletin 289 March 2020 Page 2 of 6 Billing for COVID-19 Diagnostic Laboratory Services MassHealth covers medically necessary clinical diagnostic laboratory tests when a qualified clinician orders them. Testing of persons under investigation (PUI) for COVID-19 is available through the Massachusetts State Public Health Laboratory (MA SPHL) when a patient meets clinical and epidemiologic criteria. MA SPHL does not charge providers for its provision of these laboratory services. Additionally, MassHealth does not pay providers a specimen acquisition fee (including testing supplies) or a specimen transportation fee for lab services to be rendered by MA SPHL. MassHealth-enrolled clinical laboratories and health care facilities may bill MassHealth for medically necessary, clinically appropriate COVID-19 lab tests using HCPCS code U0002, which describes 2019-nCoV Coronavirus, SARA-CoV-2/2019-nCoV (COVID-19) using any technique, multiple types or subtypes. Providers will be able to bill MassHealth for this code beginning April 1, 2020, for dates of service on or after March 12, 2020. MassHealth will issue transmittal letters that formally add this code to the relevant provider manuals. MassHealth intends to pay a rate equal to the Medicare rate for this code. For questions about testing, specimen transport, or control measures, contact the Massachusetts Department of Public Health (DPH) (24/7) at (617) 983-6800. Further information on testing can be found at DPH’s website. Billing for Covered Services Delivered via Telehealth To mitigate the spread of COVID-19, MassHealth is committed to enabling members to remain in their homes to reduce exposure and transmission, to the extent possible, and to preserve health system capacity for the duration of this public health emergency. To that end, and for as long as this bulletin remains effective, MassHealth will permit qualified providers to deliver clinically appropriate, medically necessary MassHealth-covered services to MassHealth members via telehealth (including telephone and live video) in accordance with the standards set forth in Appendix A and notwithstanding any regulation to the contrary, including the physical presence requirement at 130 CMR 433.403(A)(2). MassHealth is not imposing specific requirements for technologies used to deliver services via telehealth and will allow reimbursement for MassHealth covered services delivered through telehealth so long as such services are medically necessary and clinically appropriate and comport with the guidelines set forth in Appendix A to this bulletin. Providers are encouraged to use appropriate technologies to communicate with individuals and should, to the extent feasible, ensure the same rights to confidentiality and security as provided in face-to-face services. Providers must inform members of any relevant privacy considerations. Rates of payment for services delivered via telehealth will be the same as rates of payment for services delivered via traditional (e.g., in-person) methods set forth in the applicable regulations. Providers must include Place of Service Code 02 when submitting a claim for services delivered via telehealth. Providers will be able to bill MassHealth for these services delivered via telehealth beginning April 1, 2020, for dates of service beginning March 12, 2020. MassHealth All Provider Bulletin 289 March 2020 Page 3 of 6 Furthermore, and notwithstanding any regulation to the contrary, including the physical presence requirement at 130 CMR 433.403(A)(2), MassHealth will also reimburse physicians (including mid- level practitioners under the direction of a physician in accordance with 130 CMR 433), acute outpatient hospitals (AOHs), community health centers (CHCs), outpatient behavioral health providers, and early intervention providers for clinically appropriate, medically necessary telephone evaluations through the following CPT codes for physicians: 99441, 99442, 99443; and for qualified non-physicians: 98966, 98967, 98968. MassHealth will issue transmittal letters that formally add these codes to the relevant provider manuals. Payment rates for these codes can be found at 101 CMR 317: Medicine. Providers will be able to bill MassHealth for these telephonic codes beginning April 1, 2020, for dates of service beginning March 12, 2020. Existing performance specifications for Children’s Behavioral Health Initiative (CBHI) services allow for the telephonic delivery of services, other than for initial assessments. Notwithstanding any requirements that initial assessments be conducted in person, where appropriate, services for new clients may be initiated via telephonic means. CBHI providers should use the regular CBHI codes when billing for CBHI services delivered telephonically. Home Visits Billing for Services Related to COVID-19 MassHealth currently covers the following home visits codes under the physician and acute outpatient hospital regulations: 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 993 50, and 99600. Additionally, MassHealth will reimburse physicians and acute outpatient hospitals for clinically appropriate, medically necessary home visits using the following codes: 99500, 99501, 99502, 99503, 99504, 99505, 99506, 99507, 99509, 99511, and 99512. MassHealth will issue transmittal letters that formally add these codes to the relevant provider manuals. Providers will be able to bill MassHealth for these codes beginning April 1, 2020 for dates of service beginning March 12, 2020. MassHealth currently reimburses the following home visit codes under the community health center regulations: 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, and 99350. Additionally, MassHealth will reimburse community health centers for clinically appropriate, medically necessary home visits using the following codes: 99500, 99501, 99502, 99503, 99504, 99505, 99506, 99507, 99509, 99511, 99512, and 99600. MassHealth will issue a transmittal letter that formally adds these codes to the CHC provider manual. Providers will be able to bill MassHealth for these codes beginning April 1, 2020 for dates of service beginning March 12, 2020. Payment rates for these codes can be found at 101 CMR 317: Medicine. MassHealth All Provider Bulletin 289 March 2020 Page 4 of 6 Billing for COVID-19 Quarantine in a Hospital There may be instances in which hospitals will need to quarantine members infected with COVID- 19 for public health reasons or otherwise cannot safely discharge a member due to COVID-19 exposure or risk, even though these members may no longer require an inpatient level of care. Acute inpatient hospitals may bill MassHealth for members no longer requiring an inpatient level of care but who must be quarantined in the hospital or otherwise cannot be safely discharged due to COVID-19 by either: (1) keeping the member as an inpatient, switching the member to administrative day status, and billing accordingly, or (2) discharging the member from inpatient care, commencing observation services, and billing accordingly. Acute